Péptidos natriuréticos en la detección de disfunción ventricular izquierda en población de alto riesgo. Metaanálisis de pruebas diagnósticas

Abstract

IntroductionThe concentration of natriuretic peptides in plasma has been proposed as a screening method for early ventricular dysfunction. ObjectiveTo compare the operative characteristics of B-type natriuretic peptide (BNP) and N-terminal pro b-type natriuretic peptide (NT-proBNP) fraction in a population with risk factors. MethodA meta-analysis of diagnostic tests. ResultsA search strategy was applied that found 86 references, of which 12 were selected according to the inclusion criteria. The role of BNP was evaluated in 8 of these studies, that of NT-proBNP in 3, and both tests in one of them. The cut-off points for BNP varied between 8 and 169.5 pg/mL, with a grouped sensitivity of 82.1% (95% CI; 76.7-86.4%), a grouped specificity of 69% (95%CI; 61.5-75.6%), a positive likelihood ratio (LR+) of 2.65 (95% CI; 2.17-3.23) and a negative likelihood ratio (LR−) of 0.26 (95% CI; 0.21-0.32). When the data were only analysed for cut-off points below 50 pg/mL, the grouped sensitivity improved to 89.2% (95% CI; 82.6-94%), and the LR− was 0.23 (95% CI; 0.14-0.40). Only 3 studies on NT-proBNP were analysed, with cut-off points between 125 and 902 pg/mL, a grouped specificity of 97.2% (95% CI; 90.2-99.7%), a grouped sensitivity of 76.9% (95% CI; 74.5-79.1%), LR+ 3.39 (95% CI; 1.67-6.85), and LR− 0.07 (95% CI; 0.02-0.23). ConclusionBNP and NT-proBNP can be useful in ruling out asymptomatic left ventricular dysfunction in patients at risk.